Lil Five Eyes LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

002600 Issued in GA

Legal business name

LIL FIVE EYES LLC

Practice address

484 Moreland Ave NE
D Ste
Atlanta, GA 30307

Phone

(404) 523-3937

Fax

(404) 688-3232

NPI assigned

Mar 29, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Colay Anquanette White

Title

Owner

Phone

(404) 523-3937

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Eye Etc. Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529625600000",
    "number": "1619409729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "484 MORELAND AVE NE STE D",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303073421",
            "telephone_number": "404-523-3937",
            "fax_number": "404-688-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 MORELAND AVE NE",
            "address_2": "D STE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30307",
            "telephone_number": "404-523-3937",
            "fax_number": "404-688-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIL FIVE EYES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2018-06-22",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "COLAY",
        "authorized_official_middle_name": "ANQUANETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-523-3937"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "GA002600",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "GA",
            "license": "002600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619409729",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Etc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jarred Linton Lightner, PHARMD
• Sharon Price Lightstone, LPC
• Lightyear Health Clinic Georgia, PC
• Jan H Ligon, PHD, LCSW
• Anna Marie Likos, M.D.
• Crystal Marie Lilavois, PMHNP-BC
• Cherie Lashawn Liles
• Matthew Alan Lilien, MD
• Liliumcare LLC
• Justin Lillis, APC

• Health Maintenance Organization in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Health Maintenance Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.